Provider First Line Business Practice Location Address:
148 1/2 MAXWELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13212-1633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-430-7502
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2009